5 Determinants of health
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Overview
In this chapter you will learn about the range of factors that have an impact on the
ability of individuals, communities and societies to develop and maintain good
health and well-being. It highlights the importance of the social determinants of
health and discusses issues relating to the measurement of socio-economic status,
definitions of health inequalities and the issues that need to be addressed if health
inequalities are to be reduced.
Learning objectives
After working through this chapter,you will be better able to:
. describe the major influences on health
. understand the relationship between health and socio-economic status
. compare the four different explanations for socio-economic inequalities
in health
. understand the challenges of addressing health inequalities
Key terms
Inequalities in health Differences in health status between different population sub-groups.
Social classes Categories based on the occupation of the head of a household.
Social inequities Differences in opportunity for different population sub-groups.
What determines health?
It is recognized that the health and well-being of people is influenced by a range of
factors, both within and outside the individual's control (Lalonde, 1974; WHO,
1998). This has led to the development of a number of models that attempt to
identify the determinants of health and the pathways through which they operate.
One such model frequently used in international and national policy documents is
Dahlgren and Whitehead's (1991) 'Policy Rainbow', which describes the layers of
influence on an individual's potential for health (Figure 5.1). They describe factors
which are fixed (such as age, sex and genetic) and factors which are potentially
modifiable, expressed as a series of layers of influence, including individual lifestyle

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